| NPI | 1871797670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 241290) |
| Additional Taxonomies | 2084H0002X (Licence: NY 241290) |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: NY 241290) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NY 241290) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2025-03-19 |